When is it time to worry about the cough?

Written By Jennifer Shaer MD, FAAP, FABM, IBCL

CoughIt seems like kids cough all winter long. When is it time to worry about the cough? When can you treat it at home and when should you go to the doctor?

There are many causes of coughing in children. Most commonly, a cough is caused by a viral upper respiratory infection. However, coughs can also be caused by asthma, pneumonia, croup, bronchiolitis, whooping cough, sinusitis, allergies, reflux and even an inhaled foreign body. This article will review the …

Viral upper respiratory infections

This is the common cold. A cough from a cold will typically last two weeks. There is commonly some productive phlegm toward the end of a cold. Antibiotics do not help viral illness so it is best to let this type of cough run it’s course. It is common to have some fever with a viral upper respiratory infection for the first few days. However, you should visit the doctor if the fever lasts more than a few days. You should also be seen if the cough lasts more than a week or the fever comes back after having stopped.

Whooping cough (pertussis)

Recently there has been a resurgence of pertussis. Pertussis will start off looking like the common cold. However, instead of getting better, the cough gets worse. Children with pertussis will cough many times in a row.

They will often lose their breath and take a big “whoop” breath at the end of a series of coughs. Babies with pertussis will sometimes stop breathing and turn blue. Pertussis is extremely dangerous to babies and is preventable by vaccine. It is important to make sure that your baby gets all his pertussis vaccines. In addition, we now give teenagers and adults a pertussis vaccine.


A cough from asthma is usually not associated with a fever. Kids with asthma will cough more with exercise and at night. Asthma is usually triggered by a cold so children who have a history of wheezing should always see the doctor when they are coughing.


Bronchiolitis is when a viral upper respiratory infection moves into your baby’s chest and causes wheezing. Signs that your baby’s cold might be bronchiolitis include trouble nursing or taking a bottle, heavy or fast breathing and wet sounding cough. In general, babies with a cough should see the doctor.

To learn more about coughs, or any other medical conditions your child may be facing, visit HealthyChildren.org.

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York.


My Child Has A Fever, Should I Be Afraid?

Written By Jennifer Shaer MD, FAAP, FABM, IBCL

Everyone gets nervous when their child has a fever. However, fever is not dangerous. There are many myths surrounding fever. Here are some facts about fevers:

Fever helps the body fight infection. Fever helps slow growth of bacteria and viruses. It also enhances the immune fighting cells in the blood.

A high fever does not necessarily mean that there is a serious disease. Many viral illnesses can cause very high fevers. While these fevers might be high, they will go away without any help in three to five days.

Fevers do not cause brain damage.

Again, fever is a normal physiologic response. The only time that fever is dangerous is when it is from heat stroke or hyperthermia. Symptoms of heat stroke are red hot dry skin with no sweating and confusion.

Infections and illnesses that cause fever do not cause heat stroke and are not dangerous. It is true that a small percent of children who get a fever will have a febrile seizure. Febrile seizures occur in about 4% of kids. They can be very scary to watch but they do not cause brain damage.

Medicines to lower fever are not expected to bring the temperature down to normal.

Ibuprophen and acetaminophen are often used to bring down fever in children. However, these medicines will only help the child feel better for a short time.

When the medicine wears off, the fever will return. Your child will continue to have fever for as long as the illness lasts (usually 3-5 days). Also, these medicines will lower the fever but they are not expected to bring the temperature back to normal.

It is expected and helpful to have some fever while your child is sick.

Of course you want your child to be comfortable and you do not want your child to get dehydrated from a high fever but remember that the fever is helping your body fight infection.

Also when your child is sick, he or she should be resting. If you bring the temperature back down to normal with medicine than he will want to run around a play. The goal in using medicine for fever control is to keep your child comfortable while his body is fighting the illness.

Fevers will not continue to rise without treatment. The brain has a “set point” temperature that it will reach and then start to come down, even without medicine.

Medicines to bring down fever will not prevent a febrile seizure.

One in twenty five children will have a febrile seizure. It is impossible to predict and it is impossible to prevent. Remember that while they are scary, they are not dangerous.

Do not use medicine to try and prevent a seizure. Medicine for fever should only be used to keep your child comfortable.

It is most important to determine the cause of your child’s fever.

Fever is just a symptom.

If the fever is from strep throat or an ear infection then he might need antibiotics. If the fever is from a virus, then it will need to “run its course”.

You should bring your child to the doctor to help determine the cause of the fever. Once you know the cause, you can relax.

Medicines come in many shapes and sizes and they are dosed based on your child’s weight. To determine how much medicine your child should take, visit Allied Pediatrics – Med Dosage Resource

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York.


Your Child’s Fever, Good or Bad?

Written by Kristen Stuppy MD

Fever is scary to parents.

Parents hear about fever seizures and are afraid the temperature will get so high that it will cause permanent brain damage. In reality the way a child is acting is more important than the temperature. If they are dehydrated, having difficulty breathing, or are in extreme pain, you don’t need a thermometer to know they are sick.

Fever is uncomfortable.

Fever can make the body ache. It is often associated with other pains, such as headache or earache. Kids look miserable when they have a fever. They might appear more tired than normal. They breathe faster. Their heart pounds. They whine. Their face is flushed. They are sweaty. They might have chills.

Fever is often feared as something bad.

Parents often fear the worst with a fever: Is it pneumonia? Leukemia? Ear infection?

Fever is good in most cases.

In most instances, fever in children is good. It is a sign of a working immune system.

Fever is often associated with decreased appetite.

This decreased food intake worries parents, but if the child is drinking enough to stay hydrated, they can survive a few days without food. Kids typically increase their intake when feeling well again. Don’t force them to eat when sick, but do encourage fluids to maintain hydration.

Fever is serious in infants under 3 months, immune compromised people, and in under immunized kids.

These kids do not have very effective immune systems and are more at risk from diseases their bodies can’t fight. Any abnormal temperature (both too high and too low) should be completely evaluated in these at risk children.

Fever is inconvenient.

I hate to say it, but for many parents it is just not convenient for their kids to be sick. A big meeting at work. A child’s class party. A recital. A big game or tournament. Whatever it is, our lives are busy and we don’t want to stop for illness. Unfortunately, there is no treatment for fever that makes it become non-infectious immediately, so it is best to stay home. Don’t expose others by giving your child ibuprofen and hoping the school nurse won’t call.

Fever is a normal response to illness in most cases.

Most fevers in kids are due to viruses and run their course in 3-5 days. Parents usually want to know what temperature is too high, but that number is really unknown (probably above 106F).

The height of a fever does not tell us how serious the infection is. The higher the temperature, the more miserable a person feels. That is why it is recommended to use a fever reducer after 102F. The temperature does not need to come back to normal, it just needs to come down enough for comfort.

Fever is most common at night.

Unfortunately most illnesses are more severe at night. This has to do with the complex system of hormones in our body. It means that kids who seem “okay” during the day have more discomfort over night. This decreases everyone’s sleep and is frustrating to parents, but is common.

Fever is a time that illnesses are considered most contagious.

During a fever viral shedding is highest. It is important to keep anyone with fever away from others as much as practical (in a home, confining kids to a bedroom can help). Wash hands and surfaces that person touches often during any illness.

Continue these precautions until the child is fever free for 24 hours without fever reducers. (Remember that temperatures fluctuate, so a few hours without fever doesn’t prove that the infection is resolved.)

Fever is an elevation of normal temperature.

Normal temperature varies throughout the day, and depends on the location the temperature was taken and the type of thermometer used.

Digital thermometers have replaced glass mercury thermometers due to safety concerns with mercury. Ear thermometers are not accurate in young infants or those with wax in the ear canal. Plastic strip thermometers and pacifier thermometers give a general idea of a temperature, but are not accurate.

To identify a true fever, it is important to note the degree temperature as well as location taken. (A kiss on the forehead can let most parents know if the child is warm or hot, but doesn’t identify a true fever and therefore the need to isolate to prevent spreading illness.)

I never recommend adding or subtracting degrees to decide if it is a fever. In reality, you can look at a child to know if they are sick. The degree of temperature helps guide if they can go to school or daycare, not how you should treat the child. Fevers in children are temperatures above

  • 100.4 F (38 C) rectally
  • 99.5 F (37.5 C) in the mouth
  • 99 F (37.2 C) under the arm

Fever is rarely dangerous, though parents often fear the worst.

This is the time of year kids will be sick more than normal. With each illness there can be fever (though not always.)

What you can do?

  1. Be prepared at home with a fever reducer and know your child’s proper dosage (especially with the recent dosing changes to acetaminophen!)
  2. Use fever reducers to make kids comfortable, not to bring the temperature to normal.
  3. Have an electrolyte solution at home in case of vomiting.
  4. Teach kids to wash their hands and cover coughs and sneezes with their elbows.
  5. Stay home when sick to keep from spreading germs. It is generally okay to return to work/school when fever – free 24 hours without the use of fever reducers.
  6. Help kids rest when sick.
  7. If the fever lasts more than 3-5 days, your child looks dehydrated, is having trouble breathing, is in extreme pain, or you are concerned, your child should be seen. A physical exam (and sometimes labs or xray) is needed to identify the source of illness in these cases. A phone call cannot diagnose a source of fever.
  8. Any infant under 3 months or immune compromised child should be seen to rule out serious disease if the temperature is more than 100.5.
Dr. Stuppy is a practicing pediatrician in Kansas. I feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.  

Contagious Diseases and Siblings

Written by Jesse Hackell MD

In the fall of 1957, the Asian influenza pandemic was spreading across the country. My younger sister had just been diagnosed with that flu, and my grandmother had arrived shortly thereafter to help at our home when my mother entered the hospital to give birth to another sister. In those days, one could count of a solid seven days in the maternity hospital, even for an uncomplicated delivery.

Knowing the extremely contagious nature of the flu (she had lived through the devastating influenza pandemic of 1918), my grandmother set out with every weapon known to modern grandmotherhood to prevent my father and me from getting sick, fearing the consequences for my mother and newborn sister. With isolation, chicken soup and constant scrubbing and disinfecting, my father and I were spared the disease, as were my mother and sister, and, as long as she lived, my grandmother delighted in telling the story of how she confounded the pediatrician who had predicted that we would all very soon be ill.

Flash forward fifty-four years to 2011. What are the risks to siblings today when one member of a family contracts a communicable disease, and how should we respond? I think that the answer depends on many factors, one of which concerns the nature of the particular illness that one person has contracted.

Viral Illnesses

Some viral illnesses are highly contagious, even without direct contact. Certainly chicken pox and measles used to spread through families like wildfires, but immunization has largely reduced the occurrence of these diseases, primarily by greatly reducing the amount of disease in circulation, and, further, by producing immunity in children who might somehow be exposed. The same goes for influenza, the bane of my grandmother; since universal influenza immunization was recommended a few years ago, the burden of disease has been reduced, although not as much as it could be if everyone actually did get their flu shots.

Contagious Illnesses

How about other types of infectious, contagious illnesses? The common cold is just that, common, and most people will suffer one or multiple episodes each year. Unfortunately, there is no effective preventive immunization, and it does tend to spread readily; fortunately, it tends, in most people, to be relatively  mild and of short duration.

Strep Throat

Strep throat is another common contagious illness, especially in children. There certainly are families where multiple members will get strep in close temporal relationship to each other, and these may be the result of spread within the family.

But it is also possible that multiple family members were exposed at school or work, and contracted the illness elsewhere.  But strep is harder to spread than some of the illnesses discussed previously, and there are many cases where one family member gets it, and no one else becomes sick. This is one illness where good handwashing, and avoidance of sharing of food, utensils and so on, can be a useful preventive measure.

Infectious Mononucleosis

The same can be said for infectious mononucleosis–“mono,” also known as the “kissing disease,” primarily for its reputation as a common occurrence during adolescence. Yet in most of the families where one child has mono, it is very uncommon for other siblings to also contract it. Thus simply sharing a room, or time at the dinner table, is generally not enough to transmit an illness like mono.


Pneumonia in children is also common, and the vast majority of cases are viral in origin–and they are often caused by the same viruses which cause the common cold. I tend to think of most cases of pneumonia as “a common infection in an uncommon place,” and generally feel that, while another member of a family might catch the same virus, it is far less likely to be caught as pneumonia. Rather, it might cause a head cold, sore throat or ear infection in someone else.

So why does this matter?

Rare is the day which goes by that I am not asked a question like “his brother has strep (or pneumonia of the flu or…), so why can’t you just treat all my kids for it without having to see them?” In response, it is important to point out that every person who gets a fever after being in contact with someone who has strep is far from guaranteed to have strep as the cause of that fever; most illnesses are just not that contagious, and most fevers require individual evaluation regardless of the person’s exposure.

The same thinking goes into my response to the schools who send home notices every time someone in a class is diagnosed with strep, ostensibly warning parents to be on the lookout for strep in their children. About the only thing these notices accomplish is the wasting of paper.

I would far prefer that parents react to each of their children’s illnesses in a vacuum, paying no attention to what the child might have been exposed to (assuming, of course, that the child has been fully immunized, thus pretty effectively–but not 100% completely– ruling out those preventable illnesses as a cause of the fever.)

What to do when your child is ill

When your child is ill, pay more attention to how he or she is acting, how sick he or she appears, and how well the illness is being handled by the child, than to what diseases he or she might have been exposed to.  Discussing that information with your pediatrician will enable you to better decide what y our next course of action should be for evaluating the illness in that child.


Dr. Hackell is a founding member of Pomona Pediatrics PC, a division of Children’s and Women’s Physicians of Westchester. He practices in the lower Hudson River Valley just north of New York City.


Fall Colds: What To Do, And When To Take Your Child To The Pediatrician

Written by Jennifer Gruen MD

The fall cold and cough season seems to be in full swing. The ragweed pollen and mold in the air is also causing a lot of congestion and cough symptoms. Below are a few hints on how to make your child feel better, and when you need to bring them in for a visit:

 What constitutes a common cold?

  • Runny nose, mild cough, sore throat, decreased appetite, occasionally low grade fever (<101.)
  • Children can have 7-10 colds in one season, particularly the first year they are in any sort of a daycare or school setting.
  • Colds are most contagious in the first two days – usually accompanied by a clear runny nose.
  • The change in color of the mucous to yellow or green after 5-7 days (in the absence of fever or headache) usually signifies the end of the cold and will be gone in 2-3 days. Green noses don’t automatically need antibiotics!

Is it an allergy or a cold?

Visit this link to read more on the diagnosis and treatment of allergy symptoms.

What will help?

For children under one use nasal saline, bulb syringe, elevating mattress (put rolled up towels underneath the head of the mattress) or allowing to sleep in car seat if they can breathe more easily this way. Use nasal saline drops, with suctioning only if there is a lot of loose mucous, before feeding and sleeping. A warm bath will help bring break up the mucous.

For children 1-3, nasal saline washes may help (try Simply Saline or the NeilMed sinus rinse for children). A trial of Benadryl may be necessary to relieve congestion. (click here for dosage information.) It is especially helpful at night if cough is interrupting sleep.

For older children (>4) with congeston try mint tea with 1 teaspoon of sugar or honey to soothe sore throats and help break up congestion. For difficulty breathing through nose at night try Breathe Right strips for children. (Dr. Nikki loves them!) For persistent nighttime cough try humidifier, elevation and possibly Benadryl. Other cough syrups that we have found help include Delsym and long acting single ingredient dextromethorphan preparations.

“Just a spoonful of sugar….”- sucking on a lollipop or a teaspoon of honey has been shown to decrease sore throat as much as cough medicines. Tylenol or motrin is appropriate for fever or sore throat, but doesn’t work for cough.

When to worry?

  • Any fever >100.4 in infants less than 6 months old – call for an appointment
  • Fever for greater than 3 days in any age child
  • Fussiness, not eating well, pulling on ears, breathing quickly or pulling in at ribs when breathing.
  • Green, yellow nasal discharge that is accompanied by fever, headache, sinus pressure or that persists more than 5-7 days.
  • Drainage out of ear canals.
  • A cold that persists longer than 2 weeks, or that after several days is suddenly accompanied by a fever.
Dr. Gruen opened her practice, Village Pediatrics, in 2009, but prefers spending time creating fantastic kids birthday parties.

The Right Level of Care for the Right Illness

By Jesse Hackell, MD

The phone call came in through the answering service around 7:00 pm. “She’s four years old, Dr. Hackell, and she has a fever of 102 since this afternoon. Should I rush her to the emergency room?” Aside from the fact that I was still in the office, seeing patients until 8 that evening, as we do routinely in our office, I began thinking about the difference between an emergency, an urgent matter, a worrisome problem and an ordinary medical illness or question.

This is not a trivial distinction to make when one considers the reasons that parents seek health care for their children, and it has a great impact as well on the burden that society faces in providing, and paying for, health care.

An Emergency

An emergency is a condition where there is an immediate threat to one’s life or limb, a situation where, in the absence of prompt medical attention, there is a risk of serious, permanent or even fatal injury resulting. Examples are many, and could include a heart attack, head trauma with loss of consciousness or skull damage, prolonged seizures or asthma with respiratory distress.

An Urgent Matter

An urgent matter is not so easily defined, but might be considered a medical condition which is not life-threatening but which requires medical care to avert progression to a more serious condition which could become life-threatening. One might think of pneumonia, less severe asthma attacks, hives, persistent vomiting, and other similar examples. A worrisome problem is something which is clearly an illness, which may be causing discomfort, and which could, in theory, represent the onset of a more serious matter, but which at the moment is clearly not affecting a patient’s ability to breathe or otherwise function and interact with others. This category might include fevers, coughs, pain in the extremities, pain on urination, headaches and so on.

Ordinary Medical Issues

And finally at the bottom of the list are the ordinary medical issues, best exemplified by the itchy rash of poison ivy, pinkeye, allergies and cold symptoms.

Why does this distinction matter?

It is inarguable that conditions should be treated at the facility best able to care for the patient in an efficient and cost-effective manner. Care in emergency rooms is many times more expensive than the same care delivered in a physician’s office, and in cases other than true emergencies, as defined previously, equally effective.

Consider the child with abdominal pain, fever, loss of appetite and vomiting.

When that child is seen in a pediatrician’s office, especially the child’s “medical home” where she is known to the doctor and staff, she will be seen and carefully examined, maybe have a urine sample and blood count done, and observed for the signs that her illness might represent a true emergency such as appendicitis, in which case she would be admitted to the hospital for either more testing or for surgery.

But more likely, the results of the evaluation will be normal or non-specific, and she will be felt to have a stomach virus or cramps, and be sent home with appropriate management instructions and an admonition to return or call if more worrisome symptoms develop.

Contrast that with the same child taken to the ER.

The hospital charges for ER use are high, as are those of the ER physician. In most ERs, the child is more likely to have a battery of blood tests done, as well as an expensive CT scan of the abdomen—again, seeking to determine the presence or absence of appendicitis. Even if the child turns out, in the end, to have a stomach virus, the costs incurred in getting to that diagnosis will be vastly higher than those for the child seen in her pediatrician’s office. In addition, the time expended in the ER is likely to stretch into hours; rare, indeed, is the office visit, even with a period of observation, which exceeds an hour in duration.

While no reasonable pediatrician would attempt to manage a life-threatening condition in the office, we do see urgent conditions every single day. We take care of kids with asthma who come in wheezing, we see children who have had seizures from fever, we evaluate injuries which might break bones and we manage vomiting and dehydration—these “urgent” conditions are often able to be managed quickly, efficiently and effectively in the same offices where children get their routine examinations and immunizations.

We insure that urgent matters are attended to promptly, compared to an ER where the asthmatic child might wait for hours until after the heart attack or multiple trauma patients are seen, especially on busy evenings.

Pediatrician’s office are often a more friendly environment.

Finally, the pediatrician’s office is a place known to the child, often more child-friendly than a large, noisy and busy emergency room, so the child is likely to avoid having an already scary situation be made even more frightening by the bustle of an unfamiliar place and unfamiliar faces.

Worrisome conditions are those which do not need to be seen in an ER, either, especially at night.

We all know how kids have a knack of getting sick at night, and on weekends and holidays. But it is important to decide whether the condition is a something that can and should wait until the next morning, to be seen in the child’s regular doctor’s office, as opposed to immediately running out to the nearest hospital, often giving everyone in the family from the child on up a long, miserable night in the ER.

With more and more pediatricians adding evening and weekend hours, it is rarely the case that a sick child will need to wait much more than twelve or so hours before being seen and evaluated. Life-threatening emergencies should always go to the ER, and I would encourage parents to be over-cautious in determining what they might be worried about as an emergency.

But at the same time, with a child with a simply worrisome condition, observing the child and thinking about how ill he or she appears is the first step to deciding whether or not to “rush” to the ER. A phone call to the pediatrician can also help a parent decide the degree of urgency represented by the child’s symptoms. Many times the child with a fever or an injury looks and acts good, and can be made comfortable at home until the doctor’s office opens in the morning. This actually will make the illness easier on the child, and enable him or her to be seen in the most familiar place, reducing the stress on all concerned.

It will also generally be more cost-efficient.

There is no doubt that the American health care system is in a financial crisis, given the large proportion of our national wealth consumed by health-care services. Pediatricians certainly do not advocate skimping on health care for financial reasons; in fact, the often-expensive preventive care which is our special interest may cost money upfront, but the payback over the years in dollars saved (and improved outcomes as well) is well documented.

What we do seek to encourage is the most efficient and cost-effective use of health care dollars, in order that we, as a nation, can get the biggest bang for our buck. Making sure that our children get the level of care appropriate for the degree of their illnesses is just one step in that direction.

Dr. Hackell is a founding member of Pomona Pediatrics PC, a division of Children’s and Women’s Physicians of Westchester. He practices in the lower Hudson River Valley just north of New York City.


Many Parents are Afraid of Fever. Don’t Be.

Written by: Kerry Frommer Fierstein, MD, FAAP

In a recent article the American Academy of Pediatrics reviews the facts and fiction that surround fever in children and reminds nurses and pediatricians to better educate parents about fever.

Important fever facts:

The following information does not apply to infants under three months of age for whom you should contact your pediatrician urgently for any temperature of 100.4oF (38oC) or higher.

  • There is no “normal” temperature. 98.6 is an average and many children will normally run a little higher or a little lower. In addition, throughout the day, a given child’s temperature will vary by as much as a full degree.
  • Fever can be helpful in fighting infections. Fever slows down the growth of viruses and bacteria while activating our immune system.
  • Higher fever does not necessarily mean a more seriously ill child. Most fevers, no matter how high, are brief and not dangerous. However, if your child has a fever greater than 101 degrees Fahrenheit for more than 48 hours you should see the doctor to discover the cause of the fever.

Fevers do not cause brain damage or death. Children with fevers above 104 degrees are not at increased risk of problems because of their temperature (the one exception is heat stroke, which usually occurs from over activity in warm weather.) Fevers can cause “febrile seizures” but these types of seizures, though scary to watch, do not cause any permanent effects. Furthermore, there is no evidence that Tylenol (acetaminophen) or Motrin (ibuprofen) use will reduce the risk of fever seizures.

Parents should remember:

  • The #1 reason to bring down your child’s fever is to make him/her more comfortable.
  • It is not necessary to wake your child to give him/her fever medicine.
  • Look at your child, not the thermometer. If your child is drinking, quietly playing, or sleeping, do not worry about fever. If your child looks poorly and is too weak to drink, he/she should be seen by the doctor regardless of the temperature.

Dr. Fierstein is a practicing pediatrician. Born in the Bronx and raised in Queens, Dr. Kerry Frommer Fierstein is a New Yorker all the way. She works atPediatric Health Associates, PC, a division of Allied Pediatrics of New York.


Are High Fevers in Children Dangerous?

Written by Dr. Herschel Lessin MD

The mother of my 6-year old patient explained to me that her daughter always gets high fevers, especially when she is sick. Mom says she keeps on bringing her child in to see the pediatrician, but the doctor never seems to be concerned about it. Aren’t fevers dangerous?

The short answer is that high fevers, in and of themselves, are not dangerous in normal children. The only fevers that are dangerous are those that occur with heavy exercise in hot conditions where the body’s fever control thermostat breaks down.

Fever is a symptom, not a disease. It is not the height of the fever that is of concern, but the nature of the illness causing the fever.

In the case of viral illnesses of childhood, the body will not allow a fever to get high enough to cause damage. Unfortunately, there is a “fever phobia” in America. Surveys of parents over the past 20 years have shown little change in it.

In fact, the American Academy of Pediatrics recently issued an updated clinical report titled “Fever and Antipyretic Use in Children” The Academy says it has issued the report to help pediatricians and primary care physicians (general practitioners) educate parents and families about fever and fever phobia.

This unreasonable fear of fever stems from the basic misconception I mentioned: that fever is a disease. It is not. It is the body’s response to an infection

Like most normal bodily responses, it has a purpose. Mild to moderate fevers actually promote the body’s defense against illness. Temperatures less that 100.5 F are not fever at all, they are NORMAL. Fever’s up to 102 F rarely makes kids sick and is often beneficial.

Most Pediatricians do not consider a fever “high” until it is 104 F. or greater. Even then, the disease causing the fever may not be serious at all. A lot depends on the age and clinical appearance of the child and other symptoms that might be present.

You must assess how the child appears; how he or she is acting; do they make eye contact? Are they drinking? Are they consolable? Therefore, if your child has a fever, it is always good to call your Pediatrician for advice. It is not good to be frightened or panic and run to an emergency room, since the vast majority of fevers are caused by common viral illness.

The only exception to this advice is in the very young infant.

If your child with fever is less than 3 months of age or appears very ill, however, then an immediate call is mandatory.

Dr. Lessin has been a practicing pediatrician for 30 years. He is a founding partner and serveD as both Medical Director and Director of Clinical Research at the Children’s Medical Group.


Things Your Mother Told You That Were Wrong

by Herschel Lessin MD

My first appointment of the day is a visit I enjoy immensely: the first well baby visit for a new mother and her newborn infant. At this visit, new mothers and very often new fathers, will have their first interaction with the Pediatrician. They usually come loaded with questions. After all, babies don’t come with an instruction manual. Despite the many books on the market that try to serve as one, there is nothing like a dose of reality to make the entire process seem nothing short of overwhelming.


If you’ve ever been pregnant or had children, you’ve undoubtedly noticed an odd phenomenon. People who normally wouldn’t even consider giving unsolicited advice about your personal life seem suddenly unable to suppress their desire to tell you all the secrets of delivering and raising a healthy and happy child.

Most of the advice is very good and will work very, very well. A lot of it, however, falls into the category of “Old Wives’ Tales”.


One does not have to be an old wife to pass along an old wives’ tale. In fact, a lot of what people call “common sense” is not really very sensible. As a parent, you must make decisions that affect your children’s lives, and yours as well. It is one of your many jobs as a parent to filter through the enormous amount of well meaning advice you receive and decide which of it is useful and effective.

Your Pediatrician ought to be of some help here. A large part of pediatric practice is the giving of advice that helps parents cope with the thousands of small day to day challenges that this new young person in their lives will bring. Your doctor should be ready, willing and able not only to dispense such advice, but to comment on advice given by others and found in the media (including the Internet). My job as the Pediatrician is to give you a convincing reason why my advice might be better than your mother’s.


The care and feeding of children is a fertile area for unsolicited advice. Feeding a child has an emotional impact that is often way out of proportion to the problems involved. This is easily understood, since if we can’t even feed our children, what kind of parents are we? The wonderful truth is that our kids seem to survive and thrive no matter how we try to feed them. Now I am not talking about families in which poverty prevents children from getting enough to eat. I am talking about middle class families where this is not an issue. Here are a few pieces of advice you ought to ignore:

If you don’t force a child to eat, he’ll starve. NOT TRUE.

Young children generally eat when they are hungry, rarely overeat, and refuse food only when it they honestly don’t want it, or if it upsets their parents enough to be fun. Never fight with a child over food. You will lose.

Early introduction of solids will make a young infant sleep through the night. NOT TRUE

Infants generally do not want or need solids prior to around 4 months of age. They will sleep through the night when they are good and ready. Giving them a few spoons of cereal at bedtime which contains perhaps 20 calories will not put them out for the night.

You shouldn’t give a child with a cold, milk because it causes phlegm.

Unless your child is one of the few that are actually allergic to milk, there is no truth to this one. If your child with a cold wants milk, give it to him. No harm done.


Fever and illness is another fertile area for bad advice.

“Feed a cold, starve a fever…” or is it “Starve a cold and feed a fever?” It really doesn’t matter, since both are wrong. Good nutrition is important to all children, especially sick ones. One should maintain the best nutrition possible, regardless of colds or fever. If a child has a stomach bug, some degree of dietary restriction is often suggested, but a quick return to good nutrition is always the goal.

A high fever is dangerous.

While the disease that causes the fever may indeed be dangerous, the fever itself is not. A fever in a child that is acting well is rarely a cause for alarm. The only exception to this is in the case of heat stroke, where the body’s sweating mechanism is not working. Then body temperature can rise to 107 or higher which is a danger all by itself. In the absence of heat stroke, the temperature will not rise more than 106, which while very scary, will not, in itself cause harm. A high fever can be an indication of a serious underlying illness, so high fevers should always be discussed with your Pediatrician.

Parents are constantly asking me if it is OK to give their feverish child a bath. It is OK. A lukewarm bath may help lower the temperature and may make the child look and feel better. So bathe away — it’s not a problem. Just don’t let the child get so cold as to shiver. That will raise his internal temperature and make him feel worse.

You must keep a head injured child awake. Not Always

If your child has a head injury that is severe enough to cause loss of consciousness, it is severe enough to seek immediate medical attention. If your child has a minor head injury, it is often normal to be sleepy, but not unconscious. Trying to keep such a sleepy child awake will only make him feel worse. One should check such a child frequently to make sure he is arousable, and always call your doctor for further instructions after any significant head injury.


While most old wives tales cause only anxiety, a few can cause harm. The most common one is the advice to put something greasy like butter on a burn. This is dangerous. Grease will hold the heat inside the skin, deepening the burn and making it more severe. If your child is burned, the first thing to do is to get something cool, but not freezing, on it. This will reduce the heat and minimize the damage.

Poison ivy is dangerous if it involves the eyes.

Old wives’ tales also wrongly tell us that some very mild things are dangerous. Poison ivy on the face may cause swelling of the eyelids, but while this is very uncomfortable, it will cause no lasting harm. Oh, and by the way, poison ivy is caused by oil found on the plant. Once it is washed off, you cannot spread poison ivy by touching the affected areas.

Another worry is that one should not let a child cry because that will cause him harm or he’ll choke. This is not true. The only one harmed by prolonged crying is the parent listening to it.


There are few things in life as miserable to live through as the first 3 months of life with an infant who has colic. The old wives will tell you that there is something that you are doing to cause the colic or that there is a real medical problem. Once a good physical examination has ruled out organic illness, you should realize that not only is it NOT your fault, no one has any idea what causes colic. It is extremely common, and that there is very little anyone can do to make it better. It will, however, magically go away after the baby is 3 months old, if you live that long.


Over the years, I have heard of more complaints and illnesses attributed to teething than almost any other cause. Some facts about teething. First of all, it rarely is severe enough to wake a child up at night out of a sound sleep. If your child is up at night and has a cold, think ear infection, not teeth. Teething does NOT cause fever. It does not cause congestion or mucus and it does not cause diarrhea. It can make an awake child irritable and is best dealt with by either occasional use of rub on anesthetics or by giving a dose of acetaminophen by mouth.

Another thing new parents are often told is: “Don’t pick the baby up all the time, you’ll spoil him!” This is absolutely wrong. Young infants need to be picked up a lot in order to have normal psychological development. As they get older, they can be spoiled, but rarely by paying attention to their legitimate needs.

I am also amazed at how important it is for people to have their children be “regular.” Perhaps it’s the influence of all those laxative commercials. Being regular is of no importance to young children. Most children will find their own pattern and timing of bowel movements, from once a day to once a week for some infants. Going once a day is not special.

I’ll finish up with feet. I’ve never understood why so many grandparents feel that if you let a young infant stand up, he’ll get bow legs. He won’t. And believe it or not, buying an infant an expensive pair of shoes will not prevent flat feet. Aside from the fact that all infants have flat feet, this is rarely, if ever, a problem at any age as long as the foot is flexible. In any case, shoes make absolutely no difference.


Bringing a new baby into your lives is an exhilarating and exhausting experience. It can provoke a great deal of anxiety. I encourage new parents to seek out advice from any source of support that you can find. Just be sure that the advice is good advice, so you don’t fall victim to old wives’ tales.

Dr. Lessin has been practicing Pediatrician in the Hudson Valley since 1982. He is a founding partner and serves as both Medical Director and Director of Clinical Research at the Children’s Medical Group